| Doctor Name: | DR. CAROL R. WENZEL-RIDEOUT |
| NPI Number: | 1760609515 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSY.D. |
| License Number: | 35SI00471300 |
| Business Practice Address: | 51 Upper Montclair Plz Suite 17 Upper Montclair, NJ - 070431340 |
| Business Phone Number: | 9738099755 |
| Business Fax Number: | |
| Mailing Address: | 51 Upper Montclair Plz, Suite 17 UPPER MONTCLAIR |
| State: | NJ |
| Postal Code: | 070431340 |
| Phone Number: | 9738099755 |
| Fax Number: | |
| NPI Enumeration Date: | 04/20/2007 |
| NPI Last Update Date: | 01/31/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 35SI00471300 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |